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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004228
Report Date: 07/19/2024
Date Signed: 07/19/2024 01:49:48 PM

Document Has Been Signed on 07/19/2024 01:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HUANG, WEN YAFACILITY NUMBER:
414004228
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Licensee, Wen YaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On July 19, 2024 at approximately 9:50am, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA was greeted and granted access by licensee, Wen Ya Huang. At the entrance licensee was explained the purpose of the inspection. Present during LPA's visit included Licensee, and 4 children (3 infants and 1 preschool age).

Hours of operation are Monday through Friday. 8:00am to 6:00pm. Licensee lives in a one-level home with their spouse and child. All adults living in the home have fingerprint clearance on file.

The DAY CARE AREAS are the dinning room, living room, bathroom, bedroom #3 (napping room), and half of the backyard. The OFF LIMIT AREAS are the kitchen, bedroom #1, bedroom #2, garage, front yard, and half of the back yard. Half of backyard area is made inaccessible with child safety gates.

LPA toured day care areas of home with licensee. LPA observed home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good condition. LPA observed electrical outlets to be made inaccessible with child safety covers. Cleaning supplies, poisons and hazardous materials are stored in home's high shelves and/or locked behind child safety locked cabinets.

Home is equipped with a fully charged fire extinguisher and a dual smoke and carbon monoxide detector. Smoke and carbon monoxide detectors were tested during visit and was observed to be in working condition. There are no pools, and bodies of water in the premises.

Napping room (bedroom#1) was observed to be equipped with playpens for napping children. LPA observed playpen to have mattresses with tight fitting sheets.

Bathroom was observed to be in proper working condition. There is appropriate sanitation and toileting equipment for children in care. Per licensee, children’s families provide diapers and wipes for enrolled children. Per licensee, no children currently use the bathroom for toileting.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/19/2024 01:49 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 07/19/2024 at 12:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, WEN YA
FACILITY NUMBER: 414004228

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.3(a)(2)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (2) Room additions to the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having children sleep on an off limit area, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2024
Plan of Correction
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Licensee plans to move playpens to living room and have children sleep in livingroom. Licensee will send LPA proof of children sleeping in Family Child Care Home approved area.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024


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Document Has Been Signed on 07/19/2024 01:49 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 07/19/2024 at 12:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HUANG, WEN YA
FACILITY NUMBER: 414004228

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having infant child sleep in play pen with bib on, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2024
Plan of Correction
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Licensee plans to submit proof to LPA of children sleeping in play pens without a bibs on. Moving forward licensee plans to not let children wear bibs while sleeping.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HUANG, WEN YA
FACILITY NUMBER: 414004228
VISIT DATE: 07/19/2024
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Children eat in dining area. A food service is provided to children that includes breakfast, lunch, and snack. LPA observed eating area to be clean and equipped with appropriate dining furniture. LPA reminded licensee about dietary restrictions and allergies. Per licensee, there are no children with allergies in care.Children use age-appropriate cups and plates to eat. LPA observed knives to be made inaccessible.

Outdoor area is entirely enclosed and fenced. Outdoor area includes a variety of toys and equipment that were in good condition. Backyard has cement flooring and has a roof for shaded area. LPA did not observe any pools, spas or bodies of water on site.

LPA reviewed 4 random children's records which were complete. LPA reviewed licensee’s records, which were complete. Licensee has a current CPR/First Aid certifications and current Mandated Reporter certification. Licensee's CPR/First Aid certification will expire 07/08/2023 and Mandated Reporter certifications will expire 08/16/2024.

Licensee was reminded emergency disaster drills are to be conducted and documented. LPA observed licensing documentation to be properly posted, made available for review. Per licensee, there are firearms in the home. LPA inspected firearm weapon to be made inaccessible in an a safe, in a high shelf, and in an off-limit area.

There is one deficiency sited during today’s inspection. Per California Code of Regulations, Alterations to existing building or grounds 102416.3(Title 22, division 12 & Chapter 1) (a)(2) One-Type A citation.

LPA Zaragoza informed Licensee, Wen Ya Huang that this report dated 07/19/2024 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Zaragoza informed the licensee to provide a copy of this licensing report dated 07/19/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HUANG, WEN YA
FACILITY NUMBER: 414004228
VISIT DATE: 07/19/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.


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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HUANG, WEN YA
FACILITY NUMBER: 414004228
VISIT DATE: 07/19/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Wen Ya Huang, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the Megan’s Law search on 06/24/2024

Based on interviews, observations and record review, the licensee did not comply with California Code of Regulations Title 22 102416.3(a)(2). The licensee is being cited 1 Type A violation. See attached 809D.

Deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights was discussed with the licensee, and Appeal Rights Form (LIC9058) was given to licensee.


Exit interview conducted and report was reviewed with the licensee, Wen Ya Huang.


Licensee used interpreter from Focus Language International.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
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